Let communities lead the way on HIV

Organisations of communities living with or at risk of HIV are at the frontline of progress towards ending AIDS

Dr Stephen McWilliams, Consultant Psychiatrist, Saint John of God Hospital, Stillorgan

January 1, 2024

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  • December 1 is World AIDS Day. Marked annually since 1988, its purposes are to raise public awareness of the spread of HIV and to remember all those who have died from AIDS. It is one of eight official global public health campaigns instigated by the World Health Organization and is the creation of James W Bunn and Thomas Netter of the WHO’s Global Programme on AIDS – now known as UNAIDS. Each year has carried a different theme, ranging from gender to young people, to stigma and discrimination, to the role of the community, to human rights and universal access issues, to the prevention of spread. 

    For 2023, UNAIDS is calling on governments to let communities lead the way to end AIDS, saying that organisations of communities living with, at risk of, or affected by HIV are the frontline of progress in the HIV response.

    According to the WHO, HIV has claimed the lives of 40.4 million people worldwide as of 2022.1 Last year alone, 630,000 people died from HIV-related causes, although this number is down from 1.5 million in 2000. Similarly, the number of people who acquired HIV in 2022 (1.3 million) was less than half that of 2000 (2.8 million). However, unfortunately some countries where a decline in new infections was previously recorded are now reporting increases once again. As of the end of 2022, some 39 million people are living with HIV worldwide, around two-thirds of whom (25.6 million) reside in the WHO African Region. The WHO estimates that, in 2022, 86% of people with HIV were aware of their disease status. By comparison, this figure was 75% in 2017, a time when it was as low as 46% among women in Africa aged 15-24. In most regions across the world, more women than men receive antiretroviral treatment, Europe being the only exception. Although there is no cure for HIV, the WHO points out that: “With access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives”.  

    The goal of UNAIDS is to end the HIV epidemic by 2030. The campaign’s objectives for 2025 are that 95% of people with HIV will have a diagnosis, 95% will be in receipt of antiretroviral treatment, and 95% of the latter will be virally suppressed. In 2022, these numbers were 86%, 89% and 93% respectively. According to a recent UNAIDS report, Botswana, Eswatini, Rwanda, Tanzania and Zimbabwe have already achieved their ‘95-95-95’ targets, while a further 16 countries (eight of which are in sub-Saharan Africa) are not far off the mark.2 According to Winnie Byanyima, executive director of UNAIDS, “The end of AIDS is an opportunity for a uniquely powerful legacy for today’s leaders”.  

    Closer to home, research led by Dr Elena Vaughan at the Health Promotion Research Centre in NUI Galway found that 40% of healthcare workers worry at least in part about drawing blood from a person living with HIV, with one in five using special measures they would not employ with other patients.3 More than 400 people across Ireland took part in the survey, including 298 healthcare workers and 89 people living with HIV. Of the latter, 24% reported having been told to return later for appointments or put to the back of queues on account of their HIV status. Some 54% avoided accessing timely healthcare because of worry about stigma. Stephen O’Hare, executive director of HIV Ireland, remarked that: “This report helps us to identify areas where we can provide information and support to both healthcare workers and people living with HIV, so we can reduce HIV stigma in our healthcare system in line with our global commitments”. There is still work to do. 

    © Medmedia Publications/Hospital Doctor of Ireland 2024